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CONSUMPTION OF SWEETENED BEVERAGES

INTRODUCTION

Health problems that are linked to poor eating patterns such as heart disease, type 2 diabetes and some cancers, place an enormous burden on individuals, families and society as a whole1. Recent public health interest has focused on the associations between consumption of added sugars and adverse health outcomes. Sweetened beverages are a major source of added sugar in the diet and are seen as a target for public health intervention, as their consumption is associated with higher energy consumption, weight gain and increased risk of health problems such as dental caries, high blood pressure, type 2 diabetes and cardiovascular disease 2-9.

In the Australian Dietary Guidelines, the National Health and Medical Research Council (NHMRC) recommends limiting the intake of sugar-sweetened soft drinks and cordials, fruit drinks, vitamin waters, energy and sports drinks3. In 2006, Australia was one of the 10 highest soft drink consuming countries, based on per capita consumption10.

WHAT ARE SWEETENED BEVERAGES?

There are a range of different definitions for Sweetened beverages both nationally and internationally. For the purpose of this article, Sweetened beverages include the sub-categories: sugar-sweetened beverages, and intense-sweetened beverages.

Intense-sweetened beverages include cordials, soft drinks and flavoured mineral waters, and energy and electrolyte drinks that have been artificially sweetened.

* Fruit and vegetable drinks are water-based beverages that contain some fruit and vegetable juice in addition to added sugar and preservatives11.

WHO CONSUMED SWEETENED BEVERAGES?

In 2011-12, just under half (42%), or 9 million Australians aged 2 years and over, consumed Sweetened beverages on the day prior to interview; one-third of people (34%) consumed sugar-sweetened beverages and 10% consumed intense-sweetened beverages.

Overall, males were more likely to drink Sweetened beverages than females (46% compared with 38%). Specifically, males were more likely to drink sugar-sweetened beverages than females (39% compared with 29%), while the proportion consuming intense-sweetened beverages was similar for males and females.

Consumption of Sweetened beverages increased with age across childhood, peaking among teenagers aged 14-18 years, with 61% consuming Sweetened beverages on the day prior to interview. Two in three teenage males (67%) aged 14-18 years consumed Sweetened beverages, compared with one in two teenage females (55%). The proportion of the population consuming Sweetened beverages declined in successive older adult age groups to less than a quarter (23%) for those aged 71 years and over.

The proportion of people consuming sugar-sweetened beverages was higher for children aged 2-18 years (47%) than adults (31%).

Consumption of intense-sweetened beverages was higher among adults (11%) than children (6%) and consumers of intense-sweetened beverages tended to make up a relatively larger proportion of the consumers of Sweetened beverages among adults.

Footnote(s): (a) On the day prior to interview.

Source(s): National Nutrition and Physical Activity Survey, 2011-12

Socioeconomic characteristics

In 2011-12, people living in areas with the highest levels of socioeconomic disadvantage were more likely to drink Sweetened beverages than those living in areas of least disadvantage (47% in the most disadvantaged quintile compared with 38% in the least disadvantaged). This socioeconomic pattern was evident for sugar-sweetened beverages (38% in the most disadvantaged quintile compared with 31% in the least disadvantaged), although consumption of intense-sweetened beverages was similar across differing levels of disadvantage.

Footnote(s): (a) On the day prior to interview. (b) A lower Index of Disadvantage quintile (e.g. the first quintile) indicates relatively greater disadvantage and a lack of advantage in general. A higher Index of Disadvantage (e.g. the fifth quintile) indicates a relative lack of disadvantage and greater advantage in general.

Source(s): National Nutrition and Physical Activity Survey, 2011-12

Types of Sweetened beverages consumed

The most commonly consumed Sweetened beverages on the day prior to interview were soft drinks and flavoured mineral waters (29%), with males having consumed more than females (33% compared with 26%).

One in ten people (10%) consumed fruit and vegetable drinks, with consumption highest among children (17%).

Around 7% of people consumed cordial, with children the most common consumers (11%).

Around 3% of people consumed electrolyte and energy drinks, and fortified waters. Teenagers and young adults aged 14-30 years were the highest consumers (6%).

HOW MUCH DID PEOPLE CONSUME?

Of those who consumed Sweetened beverages on the day prior to interview, the median amount consumed was the equivalent of a regular can (375 mls), with males consuming more than females (450 mls compared with 375 mls).

The median amount of Sweetened beverages consumed generally increased with age across childhood, peaking at 519 mls for those aged 19-30 years, and decreasing over successive age groups.

Among Sweetened beverage consumers, the amount consumed varies widely. While the median amount of Sweetened beverages consumed on the day prior to interview was around the size of a regular can, the top ten per cent highest consumers of Sweetened beverages consumed more than 1L on the day prior to interview, peaking at 1.5L for males aged 19-30 years.Further analysis of the variation in amount of Sweetened beverages consumed will be published in March 2016.

Types of Sweetened beverages consumed

Of the 29% of people who consumed soft drinks and flavoured mineral waters, the median daily intake was equivalent to one regular can (375 mls).

The median daily intake of fruit and vegetable drinks by those who consumed them was just over one standard glass (290 mls).

CHANGES SINCE 1995

Consumption trends

Overall, the proportion of people aged 2 years and over who consumed Sweetened beverages decreased from 49% in 1995 to 42% in 2011-12. This was driven primarily by a decrease in consumption of cordial (from 16% in 1995 to 7% in 2011-12), with a decrease in consumption among children from 35% in 1995 to 11% in 2011-12 . The greatest decreases in consumption of Sweetened beverages were seen among children, with the proportion of children aged 2-3 years who consumed Sweetened beverages decreasing by more than half (67% compared with 31%).

Footnote(s): (a) On the day prior to interview. (b) Includes sugar- and intense sweetened electrolyte drinks for 2011-12 but only sugar-sweetened electrolyte drinks for 1995. (c) Includes sugar- and intense-sweetened energy drinks for 2011-12 but only sugar-sweetened energy drinks for 1995. (d) 2011-12 data excludes Very Remote areas of Australia.

Source(s): National Nutrition and Physical Activity Survey, 2011-12 and National Nutrition Survey, 1995

Overall, the consumption of soft drinks and flavoured mineral waters decreased from 33% in 1995 to 29% in 2011-12. While the proportion of people aged 51-70 years who consumed sugar-sweetened soft drinks and flavoured mineral waters remained similar between 1995 and 2011-12 (around 13%), consumption of intense-sweetened soft drinks and flavoured mineral waters among this age group doubled (from 5% to 11%).

Under-reporting

It is common in nutrition surveys for people to underestimate their food intakes12. This under-reporting can include:

actual changes in foods eaten because people know they will be participating in the survey

misrepresentation (deliberate, unconscious or accidental), e.g. to make their diets appear more ‘healthy’ or be quicker to report

There appears to be an increase in the level of under-reporting for males between 1995 and 2011-12, especially for males aged 9-50 years. The level of under-reporting by female respondents also appears to have increased, but to a lesser extent than for males. The apparent increases in under-reporting may account for some of the decrease in consumption of Sweetened beverages between 1995 and 2011-12.

ENERGY AND NUTRIENT INTAKE FROM SWEETENED BEVERAGES

Energy

Sweetened beverages contributed 4% of the total energy intake for people aged 2 years and over, with the proportion for males being slightly higher than for females. Teenagers aged 14-18 years consumed 6% of their energy from Sweetened beverages.

Total sugars

Sugar-sweetened beverages contributed 17% of the total sugars (natural and added) consumed overall, with more for males than females (20% compared with 14%). Soft drinks and flavoured mineral waters contributed the greatest amount to total sugars (10%), followed by fruit and vegetable drinks (4%), cordials (3%), and energy and electrolyte drinks and fortified waters (1%).

Males aged 14-18 years consumed almost one-third (31%) of their total sugars from sugar-sweetened beverages, with soft drinks and flavoured mineral waters the biggest contributor (21%). For females aged 19-30 years, Sweetened beverages contributed around one-fifth (21%) of their total sugar intake, with the majority from soft drinks and flavoured mineral waters (12%).

Footnote(s): (a) On the day prior to interview.

Source(s): National Nutrition and Physical Activity Survey, 2011-12

Of people who consumed sugar-sweetened beverages, the average amount of sugar consumed was equivalent to 13 teaspoons (54 g), with males having consumed more than females (14 teaspoons or 60 g compared with 11 teaspoons or 45 g)13. On average, teenagers aged 14-18 years consumed 14 teaspoons (58 g) of sugar from sugar-sweetened beverages with males in this age group having consumed more than females (16 teaspoons or 68 g compared with 11 teaspoons or 45 g).

While cross-sectional surveys such as the 2011-12 NNPAS cannot be used to identify causal relationships between health outcomes and behaviours or risk factors, the associations at a point in time provide an indication of current behaviours which can impact on progress of the risk factor or disease. Of the approximately 10 million Australians who were overweight or obese14, almost half 47% consumed Sweetened beverages, compared with 37% of those who were underweight or of a normal weight.

While females who were overweight or obese were more likely to drink sugar-sweetened beverages than those who were underweight or normal weight (34% compared with 27%), consumption for males was similar regardless of their body mass (around 40%). Consumption of intense-sweetened beverages among people who were overweight or obese (13%) was twice as high as for those who were underweight or normal weight (6%).

ABORIGINAL AND TORRES STRAIT ISLANDER PEOPLE

Results from the National Aboriginal and Torres Strait Islander Nutrition and Physical Activity Survey (NATSINPAS) showed that in 2012-13, more than half (56%) of Aboriginal and Torres Strait Islander people aged 2 years and over consumed Sweetened beverages on the day prior to interview, which was higher than for non-Indigenous people (42%). Half (50%) of Aboriginal and Torres Strait Islander people consumed sugar-sweetened beverages, compared with one-third of non-Indigenous people (34%). However, the proportion of people consuming intense-sweetened beverages was lower among Aboriginal and Torres Strait Islander people (7%) than non-Indigenous people (10%).

For Aboriginal and Torres Strait Islander people, consumption of Sweetened beverages increased with age across childhood, peaking at 65% for those aged 14-30 years, declining in the older age groups to 35% of the population aged 51 years and over.

Of those who consumed Sweetened beverages on the day prior to interview, the median daily amount consumed was greater for Aboriginal and Torres Strait Islander people (455 mls) than for non-Indigenous people (375 mls).

Types of Sweetened beverages consumed

Soft drinks and flavoured mineral waters were the most commonly consumed Sweetened beverages (37%) among Aboriginal and Torres Strait Islander people, with the highest among those aged 14-30 years (50%).

The proportion of Aboriginal and Torres Strait Islander children aged 2-3 years consuming soft drinks and flavoured mineral waters was three times higher than that of non-Indigenous children (18% compared with 6%). The difference was greater among males, with almost four times as many Aboriginal and Torres Strait Islander boys aged 2-3 years consuming soft drinks and flavoured mineral waters (23%) than their non-Indigenous counterparts (6%).

Around 15% of Aboriginal and Torres Strait Islander people consumed cordials, which was twice as many as non-Indigenous people (7%). Again, consumption was highest among children, and the largest difference was for girls aged 2-3 years with Aboriginal and Torres Strait Islander girls more than three times as likely to consume cordial than non-Indigenous girls (28% compared with 8%).

Around 13% of Aboriginal and Torres Strait Islander people consumed fruit and vegetable drinks, with consumption higher among children.

This analysis indicates that while two out of every five Australians consumed Sweetened beverages on any given day, there has been a decline in consumption over the past two decades. However, Sweetened beverages remain a prevalent feature in the diets of many Australians, particularly for males, people from socioeconomically disadvantaged backgrounds and Aboriginal and Torres Strait Islander people.

Further information on Australian's consumption of added sugar will be published in March 2016. This publication will present information on the usual intake of added sugars, including how much is consumed and from which food sources.

Data sources and interpretation of results

This article presents information on the consumption of Sweetened beverages among Australians aged 2 years and over, using data from the 2011-12 National Nutrition and Physical Activity Survey (NNPAS), the 2012-13 National Aboriginal and Torres Strait Islander Nutrition and Physical Activity Survey (NATSINPAS), and the 1995 National Nutrition Survey (NNS).

The information in this publication is based on the first day of the 24-hour dietary recall. The 24-hour dietary recall questionnaire collected detailed information on all foods and beverages consumed on the day prior to interview, from midnight to midnight. Information collected included the time of consumption, the name of the eating occasion (e.g. breakfast), detailed food descriptions to allow for accurate food coding, and the amount eaten. The purpose of the 24-hour dietary data collection is to estimate total intake of food, beverages, food energy, nutrients and non-nutrient food components consumed by the Australian population, to assess dietary behaviours and the relationship between diet and health. For more information about the 24-hour dietary recall, see the Australian Health Survey: Users' Guide, 2011-12 and the National Nutrition Survey: User's Guide, 1995.

Young children were encouraged to assist in answering the 24-hour dietary recall questions. See the Interviews section of Data collection for more information on proxy use in the 24-hour dietary recall module.

Under-reporting

To assist in the interpretation of data from the 2011-12 NNPAS and particularly in comparisons with the 1995 National Nutrition Survey (NNS), there are a few key points that should be noted.

It is likely that under-reporting is present in both surveys.

There appears to be an increase in the level of under-reporting for males between 1995 and 2011-12.

The level of under-reporting by female respondents also appears to have increased, but to a lesser extent than for males.

In order to achieve an EI:BMR ratio of 1.55 which is the amount required for a normally active but sedentary population, for the 2011-12 NNPAS an increase in mean energy intake of 17% for males and 21% for females is required and for the 1995 NNS, 1% for males and 16% for females and greater increases are required for overweight and obese people than those of normal weight.

Given the association of under-reporting with overweight/obesity and consciousness of socially acceptable/desirable dietary patterns, under-reporting is unlikely to affect all foods and nutrients equally.

Considerable analysis has been conducted to understand the impact under-reporting might have had on the results from the two surveys and is documented fully in the Australian Health Survey: Users' Guide, 2011-12 (cat no. 4364.0.55.001).

Amounts of all foods and beverages recorded in the NNPAS and NATSINPAS were required to be converted in grams in order to calculate nutrient values. To calculate gram amounts for the many different ways of food and beverage portions that may be reported, FSANZ developed a Food Measures Database. In the case of beverages, volumes were effectively multiplied by densities (g per ml) to derive gram weights. Therefore, the volumes of beverages consumed may be calculated by dividing the gram weight by the relevant density for that beverage. For more information about food measure and coding, please see the Australian Health Survey: Users' Guide, 2011-12 (cat. no. 4363.0.55.001).